Benussi Stefano, MD PhD
Division of Cardiac Surgery - Spedali Civili di Brescia
University of Brescia Medical School
P.le Spedali Civili 1,
25123 Brescia, Italy
Phone: +39 030 399 6401
Fax: +39 030 399 5004
Email Address:stefano.benussi@unibs.it
Stefano Benussi is consultant/proctor for Atricure, Allergan, and
Cryolife.
Other authors: No conflict of interest to disclose.
Funding: (None)
ABSTRACT INTRODUCTION
Situs inversus totalis, dextrocardia with interrupted inferior vena cava
and azygos vein continuation concomitant with symptomatic atrial
fibrillation requiring ablation. This case was deemed not suitable for
percutaneous ablation due to anatomic variations and the lack of case
reports in literature.
METHODS AND RESULTS
We performed bilateral thoracoscopic epicardial ablation and epicardial
left atrial appendage exclusion. The direct vision allowed for a
complete box lesion set with bipolar radiofrequency device. Patient
remained in sinus rhythm at 12-months follow-up.
CONCLUSION
Surgical thoracoscopic epicardial ablation is safe and effective also in
congenital defects. Multidisciplinary expertise can offer minimally
invasive ablation treatments.
KEYWORDS
Atrial fibrillation, radiofrequency ablation, surgical thoracoscopic
ablation, minimally invasive, left atrial appendage, left atrial
appendage exclusion, situs inversus totalis, dextrocardia, interrupted
inferior vena cava
INTRODUCTION
Concomitant long-persistent atrial fibrillation in a rare congenital
aberration: situs inversus totalis, dextrocardia with interrupted
inferior vena cava and azygos vein continuation. This case was deemed
not suitable for percutaneous ablation due to anatomic variations and
the lack of case reports in literature.
METHODS AND RESULTS
We performed surgical thoracoscopic epicardial ablation and concomitant
left atrial appendage exclusion. Thanks to direct vision, the complete
box lesion was performed with radiofrequency. At twelve months patient
remained in sinus rhythm.
CONCLUSION
Surgical thoracoscopic epicardial ablation is safe and effective also in
congenital defects. Multidisciplinary expertise can offer minimally
invasive ablation treatments.
KEYWORDS: Atrial fibrillation, radiofrequency ablation, surgical
thoracoscopic ablation, left atrial appendage, left atrial appendage
exclusion, congenital defects, situs inversus totalis, dextrocardia,
interrupted inferior vena cava